Observing communication skills for informed consent: an examiner's experience

To examine medical students' communication skills and competence regarding informed consent during an objective structured clinical examination (OSCE).

At the University of Toronto, 22 candidates wrote MCCQE part II as a prerequisite for medical licensure. The candidates' performance at one station involving informed consent was assessed using binary checklists and global ratings. Candidates were assessed for their clinical skills in approaching the problem, knowledge of subject matter, attitude towards the situation, and communication ability with the patient.

Of the candidates, 90 per cent performed well and demonstrated their ability to effectively deal with the patient's physical concerns. Only 50 per cent performed relevant mental-status examinations; and 50 per cent of the candidates seemed to be biased and physician-centered. They were unable to acknowledge the associated psychological issues that might influence the patient's decision in the process of informed consent. Only a few expressed their concern and empathy, and were able to guide the patient in making an autonomous decision about surgical procedures.

The OSCE seems to be an appropriate and effective means to evaluate clinical competence in psychiatry. The variation in candidates' performance, however, suggests a greater need to improve clinical skills, particularly those that are relevant to psychological considerations in obtaining informed consent and providing required information to patients. Thus, emphasis should be given in undergraduate teaching programs to addressing effective means of assessing patients' competency and their ability to give informed consent.